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- Title
The Value of Educational Messages Embedded in a Community-Based Approach to Combat Dengue Fever: A Systematic Review and Meta Regression Analysis.
- Authors
Al-Muhandis, Nada; Hunter, Paul R.
- Abstract
Background: The effects of various dengue control measures have been investigated in previous studies. The aim of this review was to investigate the relative effectiveness (RE) of different educational messages embedded in a community-based approach on the incidence of Aedes aegypti larvae using entomological measures as outcomes. Methods and Findings: A systematic electronic search using Medline, Embase, Web of Science and the Cochrane Library was carried out to March 2010. Previous systematic reviews were also assessed. Data concerning interventions, outcomes, effect size and study design were extracted. Basic meta-analyses were done for pooled effect size, heterogeneity and publication bias using Comprehensive Meta-analysis. Further analysis of heterogeneitity was done by multi-level modelling using MLwiN. 21 publications with 22 separate studies were included in this review. Meta-analysis of these 22 pooled studies showed an RE of 0.25 (95% CI 0.17–0.37), but with substantial heterogeneity (Cochran's Q = 1254, df = 21, p = <0.001,). Further analysis of this heterogeneity showed that over 60% of between study variance could be explained by just two variables; whether or not studies used historic or contemporary controls and time from intervention to assessment. When analyses were restricted to those studies using contemporary control, there was a polynomial relationship between effectiveness and time to assessment. Whether or not chemicals or other control measures were used did not appear have any effect on intervention effectiveness. Conclusion: The results suggest that such measures do appear to be effective at reducing entomological indices. However, those studies that use historical controls almost certainly overestimate the value of interventions. There is evidence that interventions are most effective some 18 to 24 months after the intervention but then subsequently decline. Author Summary: Dengue fever is a mosquito-borne viral infection that is widespread in the tropics. Each year there are an estimated 50 million infections worldwide. Preventing infection relies on controlling the mosquitoes that spread disease. Unfortunately it is still not clear what does and does not work in the control of the mosquito vector. There have been several systematic reviews into control of dengue fever but still no consensus has been reached. This lack of consensus reflects the substantial heterogeneity in published effectiveness of studies of dengue control interventions. Prior systematic reviews have not adequately addressed this heterogeneity. We used multi-level modelling meta regression to investigate what variables modify the effectiveness of studies of educational messages embedded in a community-based approach. Most of the between study variation was explained by two variables, study design and time from intervention to assessment. In particular, studies using historic controls substantially overestimated the effectiveness of the intervention compared to those studies using contemporary controls. When the analysis was restricted to just those studies using contemporary controls, effectiveness was highest about 12 to 24 months after intervention but then declined.
- Subjects
DENGUE; PUBLICATION bias; REGRESSION analysis; COMMUNITY-based programs; MULTILEVEL models; AEDES aegypti; VIRUS diseases
- Publication
PLoS Neglected Tropical Diseases, 2011, Vol 5, Issue 8, p1
- ISSN
1935-2727
- Publication type
Article
- DOI
10.1371/journal.pntd.0001278